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Matthew Holt

Turning the Clock Back Isn’t Enough: The Nasty Surprise Awaiting the GOP on Health Care and the Deficit

Jan 4, 2011• 23

By SCOTT BITTLE and JEAN JOHNSON

The Republicans who will take control of the House this January have made it clear there are two things they hate: deficits and President Obama’s healthcare reform. They’ve promised to reduce the first and repeal (or at least hobble) the second. But if you’re worried about deficits, repealing the Obama plan won’t do any good unless you’ve got a better idea. In fact, the numbers say repealing it could make the government’s budget problems worse.

Despite the outrage over spending on the Wall Street bailout, the stimulus or the Iraq war, at least these costs are temporary. But the combination of an aging population and health costs that keep rising faster than inflation means that spending on Medicare, Medicaid and Social Security are going up – – and they’ll keep going up for years on end. With an aging population, there will be more older people eligible for these programs. The health care they need will cost more on top of it.

When people argue about the costs of an aging America, they often lump Social Security and Medicare together like they were the identical twins of public policy. If they are twins, they’re more like the 1980s movie Twins, featuring Arnold Schwarzenegger and Danny DeVito as the world’s most improbable pair of brothers. Maybe you remember the iconic movie poster. It shows the two dressed alike, but with an enormous Schwarzenegger looming over DeVito. In the budget world, Medicare and Social Security are both problems, but Medicare is definitely played by Arnold. Here’s why.

Health care spending has been rising faster than the inflation rate for decades. In 2007, the Consumer Price Index went up 2.8 percent, and health spending went up 6 percent. In 1997 inflation went up 2.3 percent, and health spending went up 5.4 percent. In 1990, when inflation was 5.4 percent, health spending climbed nearly 11 percent.

Wanted: A PCAST Patient Portal

Jan 4, 2011• 3

By ADRIAN GROPPER, MD

What do the President’s Council of Advisors on Science and Technology (PCAST), the recent Institute of Medicine (IOM) report and the New England Journal of Medicine article on value in health care by Porter have in common?

They call for increasing aggregation of information around individual patients even as they seek to avoid complications for and interference with providers.

Even so, the debate between provider-centered and patient-centered health information exchange is still very much with us. Recent progress with the Direct Project, Blue Button and Kaiser’s donation of terminology suggest a trend toward simplicity and open-source collaboration as essential catalysts for health information exchange.

The next logical step is a PCAST-inspired patient portal.

The essential elements of a PCAST Patient Portal are already available:

Blue Button success proves that patients appreciate and will adopt enhanced portal features and that providers can readily connect their databases to the portal if the technical and policy requirements are truly minimal.
The Direct Project shows that combined federal and industry support can produce accessible open source code for bidirectional health information exchange in record time.

Health 2.0 Heads to San Diego: Early Bird Pricing Ends TODAY

Jan 3, 2011• 1

The New Year is here and Health 2.0 is celebrating by announcing some new updates for the Spring Fling Conference in San Diego, March 21-22, 2011 and the Fifth Annual Fall Conference is San Francisco, September 26-27, 2011. We also want to remind you that the last day to purchase the EARLY BIRD tickets for BOTH the San Diego Conference and the COMBINED tickets for both Spring and Fall is TODAY.

We are happy to be returning to San Diego with an awesome line-up of speakers including; Best-selling author, Dr. Dean Ornish, President of the Preventive Medicine Research Institute giving our keynote address and J.D. Kleinke, author of the new novel “Catching Babies”. We also have Three Great Themes where Health 2.0 technologies and services are making a big difference:

Making Health Care Cheaper – The cost of care goes up every year, and the specter of “unsustainability” looms large. Speakers who are addressing how Health 2.0 tools are being used to reduce the cost of care include Rushika Fernandopulle, President of Iora Health, which is running revolutionary primary care clinics for large employers, and Don Casey, CEO of West Wireless Health Institute which is building tools that use technology to lower costs. There will be commentary from Stephen Downs, the Assistant Vice President of the Health Group of the Robert Wood Johnson Foundation, and Margaret Laws from the California Health Care Foundation.

The Evolution Of Research – The Web has changed how health data is collected, how people learn, how research is being done, how patients are recruited for trials, and how discoveries are made. Some of the leaders in this change will tell us how they’re doing it. Hear from George Lundberg, Editor in Chief of Cancer Commons, Susan Love, President of Dr. Susan Love Research Foundation, Paul Wallace, Medical Director for Health and Productivity Management Programs, Kaiser Permanente, and Gilles Frydman,Founder, ACOR

Prevention, Wellness, Exercise & Food; We’ll take a closer look at how Health 2.0 tools can become part of the fabric for better micro-and macro-decisions about food and healthy behaviors, with a special focus on how we can make a real contribution to ending childhood obesity. As well as Dean Ornish, you’ll hear from Alan Greene, Founder of DrGreene.com and leader of the “Whiteout” movement, and Preston Maring, Founder of Kaiser Permanente Farmers’ Markets.

To find out more, check out the San Diego agenda at Health2con.com.

Health 2.0 is also excited to continue a Fall tradition. The Fifth Annual Fall Health 2.0 Conference will be in San Francisco on September 26-27. In 2011 more than 1,000 people from the worlds of technology, health plans, providers, government, finance and more will gather to see the most comprehensive line-up of technology innovation in health care, and discuss the latest changes. It’s one of the most highly rated conferences around and you want to be there.

To see the full press release please CLICK HERE

Pharmaceutical Research Expenditures and Industrial Policy

Jan 3, 2011

By FRANK PASQUALE, JD

Anyone familiar with pharmaceutical industry restructuring will not be surprised by this prediction from the FT’s John Gapper for 2011:

A drugs company will drop early-stage research. Big Pharma has struggled for a decade with a dearth of potential blockbusters. Companies such as GlaxoSmithKline have restructured and slimmed down their research arms but the sector remains troubled, as the departure of Jeff Kindler, Pfizer’s former chief executive, on the grounds of “exhaustion” indicates.

The obvious course with something that is not working is to drop it. Shire Pharmaceuticals pioneered a strategy of outsourcing early-stage research to smaller companies and focusing on developing and trialling promising drugs. This will be the year when one of the industry’s biggest takes a similar tack.

Gapper seems pretty unworried about this transition, and perhaps from the standpoint of pure economic theory it makes little difference whether research is conducted in-house or purchased from other, smaller firms. But as a matter of public relations and political economy, this is a troubling development.

The Post-R&D PR and Jobs Crises

First, the pharmaceutical industry has long justified its profits by arguing that it invests in research and development. For those who favor a market-based approach to drug research, this is a vindication of laissez-faire. Rather than relying on the heavy hand of government to try to direct the research done at pharmaceutical firms, we can expect the “invisible hand” of the market to spin off solutions for everyone’s problems–from the richest to the poorest. Innovations eventually filter down from the highest-income individuals to those with fewer resources. Spending by the wealthy on health care leads to investment in research infrastructure that ultimately redounds to the benefit of all.Continue reading…

New Year’s Resolution Diets

Jan 3, 2011

By HERBERT MATHEWSON, MD

A NEW YEAR’S RESOLUTION IS SOMETHING THAT GOES IN ONE YEAR AND OUT THE OTHER.
– attributed to both Oscar Wilde
and Anonymous
– just another reminder not to believe
everything you read on the web

It is very hard not to write about New Year’s resolutions at this time of year since almost everyone (83%) say they make them, and the majority of us (64%) are not following them six months later. Just one Google search turned up a myriad of medical New Year’s resolutions from a variety of medical institutions and medical newsletters. Some were even age-restricted; “Parental Resolutions” and “Children Resolutions” (3 different age groups). Most seem related to eating healthier, exercising more, losing weight, and new this year, “refrain from bullying”.

New Year’s resolutions probably originated in 156 B.C. when Janus, the two-faced God able to look both forward and backward at the same time, was selected as the symbol of January. Julius Caesar really closed the deal in 46 B.C.when he decreed that January would be the first month of the year. Of course, now-a-days we “have an app for it”.

One problem with resolutions is that they usually exhibit some ambiguity or are overly general, without specificity. For instance, how does one “eat healthier”? Oneprofessor of nutrition ate Twinkies, Dorrito Chips, and Oreos for 10 weeks and lost 27 pounds. His ‘bad cholesterol dropped by 20%, his “good” cholesterol increased by 20%, and his triglyceride level dropped by a whopping 40%. He did this by lowering his calorie intake from 2600 calories a day to under 1800. And that was his point. Weight loss is a result of reduced calories alone. The mix of carbohydrates, fats, and proteins is not important in a “weight-loss diet”. Any diet works, if it reduces your calorie intake.

What Would A Truly Patient-Centered ACO Look Like?

Jan 3, 2011• 14

By KENT BOTTLES, MD

Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.

Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.

However not everyone has jumped on the ACO bandwagon. Bruce Bagley, MD of the American Academy of Family Practice was recently quoted as saying, “There are probably no experts about ACOs. It’s a developing concept.” And Jeff Goldsmith, PhD, of the University of Virginia stated at the same conference: “I think this is a stupid idea. Managed care without the risk – that’s like gin and tonic without the gin. How do you end up making choices if you’re not forced to make them?”

I started thinking about what an ACO would look like if it was truly patient-centered. What if we designed an ACO that gave patients what they say they really want?

Don Berwick wrote an article in Health Affairs in 2009 that examined what patient-centered should mean, and since he became the head of Medicare in 2010 it might make sense to start there. After all, Medicare is pushing the ACO concept by creating pilot projects and encouraging the shift from fee for service payments to global payments for medical care reimbursement.

The “Unreasonable” Premium Increase Rule

Jan 3, 2011• 7

By ROGER COLLIER

HHS has now released its final set of draft regulations for provisions of the Affordable Care Act scheduled to go into effect early in 2011. This last regulatory publication—actually a “notice of proposed rulemaking” inviting comments prior to implementation—provides proposed rules for disclosure and justification of “unreasonable” premium increases.

The proposed “confess and explain” regulation requires insurers to publicly disclose rate increases in the individual or small group markets of ten percent or more in 2011, or above individual state-by-state thresholds starting in 2012. The thresholds will be set by HHS, presumably in conjunction with the states.

Although the proposed rules require review either by HHS or, if a state has an “effective rate review system,” by the state, no authority is provided for the rejection or modification of rate increases. Apparently, the Congressional drafters of the ACA language—which the proposed rule generally follows—felt that the threat of a premium increase being called unreasonable would have an adequate sentinel effect. However, insurers who show a “pattern or practice of excessive or unjustified premium increases” can also be excluded from insurance exchange participation.

Ba-Ba-Ba-Ba Boom!

Jan 3, 2011• 1

By RICHARD REECE, MD

January 1, 2011 -Yes, yes, it’s true. Today 79 million baby boomers, born from 1946 to 1964, start turning 65.

Yes, yes, it’s true. Boomers begin qualifying for Medicare.

Yes, yes, it’s true. If my math is right, this means some 12,015 boomers each day over the next 18 years will enter the Medicare ranks.

That’s the biggest news this New Year’s Day. The second biggest news is the information technology boom, triggered by IPad, Kindle, and the social media. The third biggest news, connected to the first two, is the health reform law and its impact on our unsustainable entitlement programs.

Let’s take these pieces of news, one by one.

Boomers

Boomers, whether by Botox, cosmetic surgery, exercise, antioxidants, tobacco cessation, or life-style and life-savings medical technologies, plan to maintain their youth, and to cede nothing to generations that precede or follow them. That’s if things do well. Otherwise, aging boomers who become ill, may ask , “Why me? What the hell happened?”

Does Medicare Have it Right in 2011?

Jan 3, 2011• 3

By ED PULLEN, MD

Starting in 2011 with the regulations required by the PPACA Medicare will mandate copay and deductible free preventative services for our older Americans. This is great news for primary care physicians. I’m a family physician, and have struggled for years with the fact that just about every private insurance plan covers an annual physical exam, but Medicare did not. What this anti-intuitive dichotomy accomplished was bringing in my relatively healthy 30-something patients for a physical exam each year, while for my 70 year old for whom far more preventative services were recommended by the United States Preventative Services Task Force was not covered for a preventative exam ever. Not annually, not every 3 years, just once at age 65 to last their lifetime.

As primary care physicians we tried to our best to squeeze preventative care into visits primarily for other complaints. At a visit of my diabetes patients every 3 months I’d try to focus on the diabetes and save enough time to review immunization status, assure breast and colon cancer screening was up to date, help med decide if they wanted prostate cancer screening, …. I’m looking forward to being able to ask my seniors to schedule a preventative care visit annually now and being able to focus on these issues without having to eke out time in a problem oriented visit.

Still I have to say if the goal is to provide incentive to older Americans to go to their physicians for services that will really make a difference in the health of the Medicare population problems I think congress has it wrong. If we want to prevent unnecessary hospitalizations and expensive complications from neglected medical problems, and have the biggest impact to reduce the burden of expensive medical complications and I believe the most efficacious preventative services we can offer in health care are secondary prevention and disease management. I’d love to think that by primary prevention, education, and physical exams I can help patients improve their health and subsequently reduce costs and get better outcomes. The problem is that there is little evidence that this is the case. This new regulation, offering a free once annual preventative care visit may find some early cancers, improve immunization rates and make us feel like we are being proactive.

Health Alert: Health and Education

Jan 1, 2011• 7

By JOHN GOODMAN, PhD

I believe I am one the few commentators on the Internet who routinely compares the fields of health and education (see previous posts here and here). The reason: lessons from one field are often applicable to the other.

The parallels are obvious: In both fields (1) we have systematically suppressed normal market forces; (2) the entity that pays the bill is usually separate from the beneficiaries of the spending; (3) providers of the services see the payers, not the beneficiaries, as their real customers and often shape their practice to satisfy the payers’ demands — even if the beneficiaries are made worse off; (4) even though the providers and the payers are in a constant tug-of-war over what is to be paid for and how much, the beneficiaries are almost never part of these discussions; and (5) there is rampant inefficiency on a scale not found in other markets.

Long before there was a Dartmouth Atlas for health care, education researchers found large differences in per pupil spending (more than three to one among large school districts, e.g.) that were unrelated to differences in results. In fact, study after study has found no correlation between education spending and education results. (See Linda Gorman’s summary at Econlog.)

Internationally, the parallels continue. Just as the United States is said to spend more than any other country and produce worse outcomes in health care, the same claim is now made for education.Continue reading…